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Organization
CHANGE BY CONIAH FAMILY COUNSELING, A PROFESSIONAL CORPORATION
Active
Organization
CHANGE BY CONIAH FAMILY COUNSELING, A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROL LETRESSE WALLACE LMFT (CEO)
(916) 531-5647
Entity
Organization
Contact information
Practice address
2376 MARITIME DR STE 200, ELK GROVE, CA 95758-3640
(916) 531-5647
(916) 405-3470
Mailing address
2376 MARITIME DR STE 200, ELK GROVE, CA 95758-3640
(916) 531-5647
(916) 531-5647
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LMFT48746
CA
Other
Enumeration date
08/14/2018
Last updated
08/14/2018
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